Comparison of hospital course and outcome in hospital-acquired vs pre-existing delirium.

BACKGROUND: Delirium is a major source of morbidity in the inpatient hospital setting. This study examined differences between patients with delirium present prior to hospital admission and those with hospitalacquired delirium in several health outcomes. METHODS: A total of 12,529 patients on 2 inpatient units were included in this retrospective cohort study. Outcomes were assessed using chart review. Other variables were compared across groups and included in multivariate models predicting discharge location within the hospitalacquired delirium group. RESULTS: Of 709 patients with delirium, 83% had pre-admission prevalent and 17% had post-admission incident delirium. Compared with patients with preexisting delirium, patients with hospital-acquired delirium had greater hospital durations and mortality and were more likely to receive ICU care, more likely to receive multiple classes of medications, and less likely to be discharged home without home health services. Multivariate analysis in the hospital-acquired delirium group found that several variables independently predicted discharge location. CONCLUSIONS: Patients with hospital-acquired delirium had worse hospital outcomes and a more complicated hospital course than those with preexisting delirium. Administration of various medications, several demographic variables, and some hospital-related variables were independently associated with worse outcomes within the hospital-acquired delirium group. These results demonstrate that patients with hospitalacquired delirium are a vulnerable subgroup deserving special attention.

Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing?

PURPOSE: While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. METHODS: A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. RESULTS: One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. CONCLUSION: Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Patient-Reported Outcomes and Their Predictors at Minimum 10 Years After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data.

BACKGROUND: Long-term results after anterior cruciate ligament (ACL) reconstruction are being reported with greater frequency, allowing a detailed analysis of long-term patient-reported outcomes and predictors. PURPOSE: To summarize expected patient-reported outcomes at a minimum 10 years following ACL reconstruction and to explore patient and surgical factors that affect these results. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: Prospective studies detailing patient-reported outcomes with a minimum follow-up of 10 years were identified. Average scores for each outcome measure were calculated. Factors identified in each paper as predictors of patient-reported outcomes were identified and described. RESULTS: Thirteen studies met inclusion and exclusion criteria. Lysholm scores were reported in 317 of 406 patients (78.1%) in 6 studies, with a mean score of 91.7 ± 11.2. Subjective International Knee Documentation Committee scores were reported in 1726 of 2611 patients (66.1%) in 5 studies, with a mean score of 84.2 ± 15.5. Cincinnati knee scores were reported in 1323 of 1801 patients (73.5%) in 3 studies, with a mean score of 87.4 ± 14.4. Tegner activity scores were reported in 728 of 914 patients (79.6%) in 8 studies, with a mean score of 5.1. There was mixed evidence that meniscectomy and articular cartilage damage were associated with poorer patient-reported outcomes. Patient sex and graft choice did not affect patient-reported outcomes. CONCLUSION: Patient-reported outcomes are generally good at a minimum of 10 tears following ACL reconstruction. Further large prospective studies with regression modeling and consistent outcome reporting will clarify predictors of outcomes.